Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Diabetes Metab Res Rev. 2012 Jul;28(5):439-46. doi: 10.1002/dmrr.2297. Epub 2012 Mar 8.
Gut hormones play a role in diabetes remission after a Roux-en-Y gastric bypass (RYGB). Our aim was to investigate differences in gut hormone secretion according to diabetes remission after surgery. Second, we aimed to identify differences in insulin secretion and sensitivity according to diabetes remission after RYGB.
Twenty-two severely obese patients with type 2 diabetes underwent RYGB. A meal tolerance test (MTT) was performed 12 months after RYGB. The secretions of active glucagon-like peptide-1 (active GLP-1), glucose-dependent insulinotropic peptide (GIP), peptide YY, C-peptide and insulin during the MTT test were calculated using total area under the curve values (AUC). Remission was defined as glycated haemoglobin (A(1C)) of <6.5% and a fasting glucose concentration of <126 mg/dL for 1 year or more without active pharmacological therapy.
Of the 22 patients, 16 (73%) had diabetes remission (remission group). The secretion CURVES of active GLP-1, GIP and peptide YY were not different between the groups. AUC of insulin and C-peptide were also not different. Homeostasis model assessment estimate of insulin resistance was significantly lower (1.26 ± 1.05 versus 2.37 ± 1.08, p = 0.006), and Matsuda index of insulin sensitivity was significantly higher in the remission group (10.5 ± 6.2 versus 5.8 ± 2.1, p = 0.039). The disposition index (functional reserve of beta cells) was significantly higher in the remission group compared with that in the non-remission group (5.34 ± 2.74 versus 1.83 ± 0.70, p < 0.001).
Remission of diabetes after RYGB is not associated with a difference in gut hormone secretion. Patients remaining diabetic had higher insulin resistance and decreased β cell functional reserve.
肠激素在 Roux-en-Y 胃旁路（RYGB）手术后的糖尿病缓解中发挥作用。我们的目的是根据手术后糖尿病缓解情况，研究肠激素分泌的差异。其次，我们旨在根据 RYGB 后糖尿病缓解情况，研究胰岛素分泌和敏感性的差异。
22 例 2 型糖尿病肥胖患者接受 RYGB。RYGB 后 12 个月进行餐耐量试验（MTT）。使用总曲线下面积值（AUC）计算 MTT 试验期间活性胰高血糖素样肽-1（active GLP-1）、葡萄糖依赖性胰岛素释放肽（GIP）、肽 YY、C 肽和胰岛素的分泌。缓解定义为糖化血红蛋白（A1C）<6.5%，空腹血糖浓度<126mg/dL 1 年或以上，无活性药物治疗。
22 例患者中，16 例（73%）糖尿病缓解（缓解组）。两组间 active GLP-1、GIP 和肽 YY 的分泌曲线无差异。胰岛素和 C 肽的 AUC 也无差异。胰岛素抵抗的稳态模型评估估计值显著降低（1.26±1.05 与 2.37±1.08，p=0.006），胰岛素敏感性的 Matsuda 指数在缓解组显著升高（10.5±6.2 与 5.8±2.1，p=0.039）。与未缓解组相比，缓解组的处置指数（β细胞功能储备）显著升高（5.34±2.74 与 1.83±0.70，p<0.001）。
RYGB 后糖尿病的缓解与肠激素分泌无差异。糖尿病患者仍存在胰岛素抵抗和β细胞功能储备降低。
